Appointment of Treasurer_Richard Sartory_9/12/2023 APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN RECEIVED tf
DEPOSITORY FOR CANDIDATES 1 „ �'�
(Section 106.021(1), F.S.) SEP 12 2023 !+�►V
(PLEASE PRINT OR TYPE) VILLAGE CLERKS OFFICE
NOTE: This form must be on file with the qualifying officer
before opening the campaign account. OFFICE USE ONLY
1.CHECK APPROPRIATE BOX(ES):
MInitial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state,
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4. Telephone i Candidate's Vot��gistration #: i� ,) �(� C l�, �� 3 3 1,,�0
( ( ) Cep 3 q l G(, J
(Not required for Qualifying Purposes)
(Not required for Qualifying Purposes)-Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on
the audio ballot as ma be used by persons with disabilities see instructions on page 2 of this form):
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6. Office sought(include district circuit,
group number) 7. If a candidate for a nonpartisan office, check if
V(L,L,/�6,4, applicable:
51,A-1r S ❑ My intent is to run as a Write-In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
_] Write-In 0 No Parry Affiliation ❑ Party candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer 11. Telephone
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12. Mailing Address 13. City 14. Stake 15. ip Code
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16. 1 have designated the following bank as my ;R-, Primary Depository ❑ Secondary Depository
17. Name of Bank Address
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19. City 20. County 21. Stag 22. Zip Code
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN AT ARE TRUE.
23. Date 24. Signature of Candi t
25. Treasurer's Acceptance of Appointment(fill in the blanks and c ec a appro riate block)
1` �t-�'� L„1, � �A - 5 n t^-� l do hereby accept the appointment
(Please Print or Type Name)
.,ignated above as: Campaign Treasurer. ❑ Deputy Tre ur
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Date Signature of Car4aig reatrer o ep ty Treasurer
DS-DE 9(Rev.07123) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF RECEIVED
CANDIDATE SEP 12 2023
(Section 106.023, F.S.)
VILLAGE CLERKS OFFICE
(Please print or type)
C �IA-1% L . S ram.T-�>(� _
candidate for the office of Vt���l'fo4. �f �GZk�s 1+� CSv�ac,
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X
Sig katu p f Ca i ate Date
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful
failure to file this form is a first degree misdemeanor and a civil violation of the Campaign
Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS-DE 84(05111)